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How Do Lay People Interpret and Respond to Suicide Warning Signs?

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How Do Lay People Interpret and Respond to Suicide Warning Signs? Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. How do lay people interpret and respond to suicide warning signs? A thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology. School of Psychology, Massey University, New Zealand Amber McAllister 2017 ABSTRACT Suicide is a worldwide problem with over 800,000 people dying by suicide every year, and many more attempting suicide or thinking of suicide. Despite prevention efforts, suicide rates are increasing. One promising area of prevention is educating the public to recognise and respond to suicidal signs. Yet knowledge of this area is currently lacking in the literature, especially in New Zealand. The aim of this study was to understand and explore how lay people in New Zealand currently interpret and respond to suicidal signs. A second aim was to assess whether there were gender or age group differences. A mixed methods approach was used that included a validated questionnaire and a semi-structured vignette interview developed specifically for the study. Participants were 24 adults from one location in New Zealand, grouped equally by gender and age (20-30 years or 40-50 years). The results reveal a number of psychological, cognitive, and communicative barriers to interpretation and intervention, and a lack of intervention knowledge. Small gender and age group differences are also revealed. These findings have implications and recommendations for suicide prevention strategies in New Zealand. !! ACKNOWLEDGEMENTS I have greatly enjoyed writing my Master’s thesis this year. It would not have been possible without these people. First and foremost, my husband Chris. You have given me your unwavering support and encouragement this year, and enabled me to pursue my goals- so thank you. Without your support, I would not have been able to undertake this study. To my children Cullen, Ava, and Lulu. Thank you for being understanding when I have had to write or have been distracted with my research. You brighten my life each and every day and I love you. I must thank my supervisor Dr John Fitzgerald. I am so grateful for your feedback, advice, and support. You are a great supervisor and I feel very fortunate to have worked with you this year. Thank you to the Massey University Human Ethics Committee for your comments, feedback, and approval. Finally, I would like to thank my 24 participants- thank you for choosing to take part in this research. It would not have been possible without you. !!! TABLE OF CONTENTS Page Abstract ii Acknowledgements iii List of Tables vi List of Figures vii INTRODUCTION 1 International suicide rates and perspectives 6 New Zealand suicide rates and perspectives 7 Suicide prevention in New Zealand 12 LITERATURE REVIEW 16 Suicide prevention/education programmes 16 Suicide communication 21 Attitudes toward suicide 34 The current study, aims, and hypotheses 43 METHODOLOGY 46 Participants 48 Measures 49 Attitudes Towards Suicide Scale (ATTS) 49 Demographic survey 51 Vignettes 52 Procedure 53 !. Data analysis 55 RESULTS 58 Quantitative results Whole sample results 58 Group differences 64 Qualitative results Thematic analysis 70 DISCUSSION 99 Review of main aim and findings Implications for theory 110 Practical implications for prevention 112 Practical recommendations 115 Limitations of the present study 116 Future research directions 118 REFERENCES 119 APPENDIX A: Participant information sheet and community 137 resource sheet APPENDIX B: Participant consent form 142 APPENDIX C: Demographic questions and general suicide statements 143 APPENDIX D: Attitudes Towards Suicide questionnaire (ATTS) 145 APPENDIX E: Vignettes and interview guide 149 . LIST OF TABLES Table 1. Classification and definitions of suicidal behaviour 4 2. New Zealand provisional suicide deaths and rates per 100,000 8 2007-2017 3. Latest provisional suicide deaths and rates by age group 9 July 2016-June 2017 4. Descriptive statistics for the three ATTS subscales 59 5. Vignette percentage frequencies for asking outright, confidence level, and intentions to intervene 62 6. Median and IQR for the two age groups for each gender 65 7. Inferential statistics for gender and age group differences on attitudes 66 toward communication beliefs, taboo, and preventability 8. Individual vignette scores for age group, gender, and experience 66 9. Themes found through thematic analysis of vignette interviews 71 .! LIST OF FIGURES Figure 1. Age-standardised suicide rates by country 7 2. ATTS subscales that are mosr applicable for this study 51 3. An example of the vignettes used in this study- MARY 53 4. The relationship between level of confidence and intentions toward 61 intervening with suicidal persons as indicated by participants 5. The warning signs identified by participants, and the proportion of 63 times these were recognised 6. The total amount of participants that considered these interventions 64 to be appropriate 7. Participants grouped by age group and gender 70 .!! Introduction and Rationale Suicide is a major issue in New Zealand and around the world. Prevention efforts so far have failed to decrease suicide rates, so further research is needed to understand what strategies may be effective. One area that has potential as a prevention strategy is utilising the public to recognise and respond to suicide warning signs. However, there is scarce research about this group, especially in New Zealand. Therefore the aim of the current study is to explore and understand what lay people currently know about warning signs and how they believe they would respond to someone suicidal. The current section will provide an introduction and rationale for the study by providing international and national suicide statistics, defining and describing suicide behaviour, as well as risk factors and warning signs for suicide. Then the literature review will focus on current prevention programmes, the suicide communication literature, and the literature on attitudes to suicide. Within this section, will be a review of the tripartite theory of attitude and the theory of planned behaviour, as these models may be useful for the helping intentions of lay people. Following this is the methodology section, the results section, which consists of both quantitative and thematic analyses, and finally a discussion of the results which will incorporate limitations and further research recommendations. More than 800,000 people die by suicide every year, a figure that translates to one person dying by suicide every 40 seconds (World Health Organization, 2017). It is a worldwide problem with no cultures or countries exempt (WHO, 2017). For many countries it is one of the top ten causes of death, and in some age groups it is even higher. In the 15-29 year age group, it is the second highest cause of death (WHO, 2017). In addition, there are many more who attempt but do not die by suicide, with the World Health Organization G (WHO) indicating that for each adult that dies by suicide, 20 others may attempt suicide. Completed suicides also have a substantial secondary impact on a person’s family, community, and society (WHO, 2017). Although official suicide rates show that suicide is a leading cause of death in most countries, there is a general consensus that these rates may underrepresent total suicides due to cultural and national differences (Rogers & Lester, 2010). In some countries, suicide is underreported because it is considered taboo, or because of stigma or its illegal status. Suicide may be misclassified when cause of death is unclear, or mistakenly classified when there appears to be a more obvious cause. For instance, sole occupant car accidents can be classified as death by accident yet may actually be an act of suicide. Research has also pointed to differences in classifications, and therefore rates, depending on the coroner’s background (Rogers & Lester, 2010). Cultural factors can further influence whether a death is considered suicide, such as the death of young women by domestic burning in such countries as India and Iran following domestic disputes with their husband’s or in-law families (Canetto, 2008). In such instances, it can be difficult to know whether a death is an accident, a suicide, or a homicide. Another general consensus regarding suicide is that it tends to affect people differently to other types of deaths. The affect may be more intense; where grief may be intertwined with confusion, anger, guilt, blame, and shame, partly as a consequence of the stigma that accompanies suicide. Those who had contact with the deceased prior to their death wonder if they could have done something to prevent the death. Also, the impact of the death appears to be more far-reaching, affecting not only family and friends of the deceased but the wider community too (WHO, 2017). Moreover, the death of a person to suicide can H increase suicide risk within the family of the deceased and the community. A family history of suicide is a risk factor for suicide (whether this is due to genetics, the role modelling of behaviour, or both, is less clear), and community risk has been shown with the phenomenon of suicide clustering, where there are clusters of suicides within the community after a known person commits suicide. This clustering of suicide, especially when initial suicide involves a celebrity, is a main reason why there are media embargoes when writing about a person’s death by suicide (Pirkis, Blood, Beautrais, Burgess, & Skehan, 2006). Suicide Definitions and Classifications This section defines and describes suicidal behaviour. Egmond and Diekstra (1989) define suicide as: “An act with a fatal outcome; that is deliberately initiated and performed by the deceased him or herself, in the knowledge or expectation of its fatal outcome, the outcome being considered by the actor as instrumental in bringing about desired changes in consciousness and social conditions” (p.
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